Electronic Health Records: More than digital files

00:00:03: RePlay by Hannover Re.

00:00:05: Expert insights on life and health insurance.

00:00:15: What role electronic health records play in our industry, why they are important for enabling accurate and inclusive insurance processes, and how they are being used in underwriting and claims.

00:00:27: Welcome to RePlay by Hannover Re.

00:00:29: I'm your host Susanne Loomis, and today we'll talk to Monique Esterhuizen about electronic health

00:00:33: records.

00:00:34: This podcast is for general information only, no professional advice and is subject to change.

00:00:39: You can find the full disclaimer in our show notes.

00:00:42: Oh,

00:00:43: thank you so much.

00:00:44: It's always great to see you.

00:00:46: Monique is chief medical officer and head of medical and health services at our subsidiary in Sydney, Australia.

00:00:53: And you came to visit us all the way.

00:00:55: She spent years bridging clinical practice and insurance and helped guide medical strategy and risk assessment.

00:01:03: So Monique, before stepping into the insurance world, you worked as a medical doctor, first as general practitioner and later in trauma care.

00:01:13: So you know firsthand how important medical files are and that's what we want to talk about today, electronic health records.

00:01:21: And most of our listeners are familiar with them, but can you tell us why they are such an important topic in our industry and what makes them more than just a digital version of a medical file?

00:01:34: Absolutely, that's a great question and there are many fantastic ways that electronic health records are already being used in life insurance.

00:01:42: If we look at underwriting and claims, having access to a person's full medical records and you know with their consent of course.

00:01:49: can allow us to make more accurate and tailored decisions as opposed to relying on self-disclosed information, which is sometimes outdated or even incomplete.

00:01:59: So absolutely, this is a huge step forward for insurance becoming more inclusive and accessible for people.

00:02:05: Right.

00:02:06: So it's not just all about the access, but it's also about what you can do with the data.

00:02:12: Well, exactly.

00:02:13: And one of the beautiful things about electronic health records is that it comes in a very structured format.

00:02:19: This means that when we're looking at it right at the beginning of our life insurance value chain and we're accessing that data, we can really integrate it into systems and that allows for automation to occur in a really effective way.

00:02:32: If we move into the enforce policy landscape.

00:02:36: We also tap into a range of opportunities where we can use the EHRs to provide data insights.

00:02:43: Now, we could do that through dashboards, for example.

00:02:46: And we can also look at providing preventive health care for our members or our policy holders.

00:02:52: We can do this through nudging them, encouraging them or incentivizing them to live healthier lives.

00:02:57: And that's good, not just for insurers, but also for them, you know, being healthier overall.

00:03:03: Finally, if we think about product development, we can use these records to really develop and tailor bespoke products, simplified products if you like, and that's a real win.

00:03:13: Yeah, that sounds very complex, but I know you've run half marathons, you swim in open waters, and I'm guessing your endurance and finding the best possible solution into complex situations is very high.

00:03:27: Yeah, that's a superb connection.

00:03:29: Absolutely.

00:03:30: Things like endurance sports and the projects that we run both absolutely require a degree of endurance and perseverance.

00:03:38: I will probably say that they both need a very supportive surrounding structure.

00:03:44: And for me, I was supportive with my team around me.

00:03:48: I got to work with my close colleague Priya Nagalingam, who we spent hundreds of hours, you know, whiteboarding different aspects of the project, but also underwriting teams, our claims teams, operations teams, who are really instrumental in the project design, the implementation and the execution of our projects.

00:04:05: And then finally, the completion of them.

00:04:09: So how do you approach situations that seem huge at first.

00:04:14: In my career, I've often found myself facing projects that, well, on the surface seem really overwhelming or even impossible to solve.

00:04:22: But just like preparing for a long distance race, you break that situation down into smaller pieces or segments.

00:04:27: You think about what do I need to achieve today or next week?

00:04:31: And before you look, you're actually at that halfway mark and you can see the finish line.

00:04:35: It's tremendously exciting, inspirational, it keeps you going.

00:04:40: We also had to change and pivot on the elements.

00:04:42: When things change and you face new challenges, you steer yourself in a new direction.

00:04:48: So lots of grits and resilience pushing through all of that.

00:04:51: But that's what it's all about.

00:04:52: It's an opportunity to dig deep and really make an impact.

00:04:55: Yeah, that's a great perspective.

00:04:57: So mindset really makes the difference.

00:05:00: And did you come across some hurdles in accessing and using electronic health records in life and health?

00:05:07: Honestly, there were a few big hurdles when it came to using EHRs in life insurance.

00:05:13: First off is the customer consent.

00:05:15: That is huge.

00:05:16: It needs to be simple and it needs to be transparent.

00:05:20: You know, customers really need to know what they're agreeing into.

00:05:24: And then there's the trust from GPs.

00:05:26: We actually found that a lot of GPs were hesitant to release their data to us.

00:05:31: They were concerned about how we would be using that data.

00:05:34: And also the concerns around how using electronic health records would disrupt their already busy workflows.

00:05:41: Yeah, that's a valid point.

00:05:44: Yeah, and another thing to consider is the data quality.

00:05:46: We actually had very different types of data quality coming through.

00:05:50: In some instances, you see the dates of being really robust, structured, and very rich.

00:05:55: And in other instances, you see it being very poor quality, very scanty, and almost questioning the value of it.

00:06:02: And then finally, I would say that we really needed to rely on GPs to release those records, particularly in Australia.

00:06:11: And this, of course, can then result in delays.

00:06:13: Sometimes GPs aren't available.

00:06:14: They've gone away on leave or they're just on vacation.

00:06:18: So that could really be a challenge.

00:06:20: So you've worked on different pilots related to EHRs.

00:06:23: Can you share some information about that?

00:06:25: Yeah, sure.

00:06:26: We've actually run a few pilots in Australia.

00:06:29: We started our first pilots around five or six years ago, and the first one involved acquiring sixty thousand GP records.

00:06:37: We did this in an offline environment, and we were very curious to see whether these records held information and health data that was compatible with our underwriting rules.

00:06:49: We were also interested to see which conditions were being disclosed and coming through.

00:06:54: It turns out that most applicants or patients didn't have a lot of significant conditions on their records, which wasn't really a surprise.

00:07:02: We see that in underwriting all the time, that it's healthier lives coming through.

00:07:06: But that was a really interesting observation.

00:07:09: Our second pilot dug a little bit deeper.

00:07:13: In this instance, we were very interested in the substandard disclosure.

00:07:17: So these are the reports of medical conditions coming through where someone had something significant to disclose.

00:07:24: And here, we were really interested in looking at how consistently that data was coming through.

00:07:30: for a particular condition.

00:07:31: So if we say diabetes, for example, how often do all the data requirements for a diabetic come through and allow us then to make an automated full decision on that application?

00:07:44: Our third pilot was the live pilots in a direct to consumer setting.

00:07:47: Now, this was especially cool.

00:07:49: One third of people who were previously declined cover actually got a second chance at underwriting.

00:07:56: And over half of these cases received offers.

00:08:00: It really shows the power and the potential of EHRs, but it highlights the need for smoother onboarding by the GPs.

00:08:07: Yeah.

00:08:07: And was there a moment that really surprised you?

00:08:11: Honestly, one of the biggest surprises for us during the pilot was just how cautious GPs were when it came to onboarding these new processors.

00:08:19: The uptake rate was actually a lot lower than we had anticipated, with many GPs opting for the more tedious, cumbersome manual handwritten But familiar approach.

00:08:30: Yeah, I didn't expect that.

00:08:31: And once we started working with the GPs, we noticed building practices were all over the map.

00:08:36: There was no standard approach and this made it a little unpredictable for us on our end.

00:08:41: So it was a difficult element to navigate through and certainly added a layer of complexity to the project.

00:08:47: Yeah, and what did you do about it?

00:08:49: Well, one of the biggest things we learned was that building trust with GPs really took time and effort.

00:08:56: We couldn't just introduce a new system.

00:08:58: and then expect immediate buy-in.

00:09:00: Now, having worked as a GP previously myself, I could totally appreciate the concerns we had experienced as patient.

00:09:08: privacy really is everything.

00:09:10: Yeah, I'm sure that's a very helpful perspective to have.

00:09:13: Our EHR vendor was also really instrumental in building the relationships with GPs, communicating with them, troubleshooting, and ensuring they were comfortable with the process.

00:09:24: We were generally transparent about every aspect of the step.

00:09:27: And that was important for GPs to know that their patient's information would be really safe and confidential and importantly used in the right way.

00:09:35: At the heart of it all, I would say the human element was really key, connecting on a personal level and showing that we truly understood their concerns and their worries.

00:09:43: Ultimately, then we could just, you know, take that move forward and get past it all.

00:09:46: Yeah, that sounds like your approach to transparency and just relationship building was key.

00:09:54: So what's one myth?

00:09:57: about electronic health records in insurance that you wish you could retire.

00:10:02: One myth I'd love to bust isn't the idea that EHRs are just too messy to be useful.

00:10:08: In reality, when you have the right governance in place and the right tools to work with, EHRs can be exceptionally powerful for supporting better decisions for insurance.

00:10:18: So it's all about how you approach it.

00:10:20: Structure and smart systems really unlock their true value.

00:10:24: And can you share a story with us that shows how EHRs can make a real difference?

00:10:31: Well, let me share a real example with you.

00:10:33: Let's take Julianne.

00:10:35: She's thirty-eight.

00:10:36: She tried to get life insurance through a direct to consumer or DTC platform.

00:10:41: Her application flagged a chronic condition and she was then turned down right away.

00:10:47: Now, if we'd had access to her EHRs, With her consent, of course, we could have checked her complete medical history.

00:10:55: We could have seen that the conditions was actually managed well and under control.

00:11:00: Her labs were stable.

00:11:02: Her medications were consistent.

00:11:03: And generally, there were just no complications to be concerned about.

00:11:07: Essentially, with that information, we might have been able to approve her application quite quickly.

00:11:13: Yeah, that could have been a game changer.

00:11:15: Yeah, and this really highlights why the current DTC process doesn't always work, especially for someone like Julianne who just prefers the digital accessible channels and may not want to go through the whole rounds of new medical exams.

00:11:29: There's often a protection gap for people like her who can't get coverage in a DTC environment.

00:11:35: And that means missing out on financial security, not just for her, but also for her family.

00:11:41: Now, EHRs can really bridge that gap.

00:11:44: Yeah.

00:11:44: What if there's no information to refer to?

00:11:47: Okay.

00:11:47: Well, let me give you another example.

00:11:49: Let's take James, who's forty two and he tried to get coverage through the DC channel.

00:11:55: He was declined because of an old vague note of some information from years back.

00:12:00: that wasn't very clear.

00:12:02: There wasn't a clarity around what his condition was about.

00:12:05: It's not to say it was necessarily high risk, but the lack of context, the lack of information made it really difficult to proceed with a decision.

00:12:13: Now if we had had access to his EHR with his consent, we could have seen that it was something resolved many years ago having no further medical consequences and we could have potentially offered him cover again another missed opportunity.

00:12:28: Yeah, that highlights the gap very well.

00:12:31: Now look, it's important to keep in mind as well that EHRs are really part of a bigger story.

00:12:37: Sometimes there's no information at all.

00:12:39: This could be maybe James hasn't been to his doctor for many, many years.

00:12:43: He's just been really healthy.

00:12:45: Or perhaps his GP doesn't have an electronic health system, isn't on a practice management system, still using handwritten records or in an old fashioned manual sense.

00:12:55: And so that could also pose itself as an opportunity.

00:12:59: Basically, in these instances, we can also look to tap into other third-party health data sources to help fill those gaps, whether it be through wearable data.

00:13:08: Sometimes it can be prescription data.

00:13:10: It could be the lab results that they can tap into, some Medicare records just to give a few examples.

00:13:17: Yeah, absolutely.

00:13:18: That's a great point.

00:13:20: EHRs are just one piece of the puzzle.

00:13:22: So what do you say, could AI help make sense of EHRs?

00:13:27: Yeah, absolutely.

00:13:29: Look, AI is already playing an impactful role in how we use EHRs.

00:13:34: It's also important, though, to remember that the value of AI often depends on the quality of the data coming in.

00:13:41: Right.

00:13:41: You know, if a healthcare record provider enters information in a really structured way, you sometimes you just don't need AI.

00:13:49: But when there are lots of unstructured data coming through, that's really where the gold is.

00:13:55: And we can use the AI to sort through that noise.

00:13:57: Sometimes it's handwritten notes coming through or consultation records where they lack structure.

00:14:03: AI can really cut through that and surface the pertinent information that we need in order to assess what matters most.

00:14:10: Right.

00:14:10: And what about the claims space?

00:14:13: What opportunities do you see for improving the claims journey using EHRs?

00:14:19: Well, we're seeing some of the most transformative impact from EHRs in the claim space right now.

00:14:25: The claim space is where EHRs are making a real difference.

00:14:29: We're doing this in a slightly different way.

00:14:31: We're using digital structured claim forms, using it in combination with electronic health data to extract.

00:14:39: the pertinent information for that claim.

00:14:41: This is really important under the code of practice where we specifically don't want to be fishing for unnecessary information.

00:14:47: We only want to extract information that is relevant to that claim.

00:14:51: Right.

00:14:53: So how does it work

00:14:54: then?

00:14:55: Well, let's take a policy holder that submits a claim.

00:14:59: We say for income protection, we would then generate an income protection claim form that would then go to a GP's workflow to be opened and accessed.

00:15:09: And when they do that, that would then extract and integrate with the EHR data and populate the form with the relevant information.

00:15:19: It also can add reflexive questions to GPs, which is a fantastic way of obtaining qualitative information that it can complement the claim form data, but also fill in any gaps that there might be.

00:15:33: It avoids having to go back and forth to the GP to get extra information.

00:15:38: We really can get that information in one hits, one contact with the GP.

00:15:42: And that streamlines the process.

00:15:44: It means that when we get the data, we can plug it into our claims rules, automate those rules, and really for simple products, we can really make decisions fast.

00:15:53: That's really good.

00:15:54: And are you seeing how this plays out?

00:15:57: Well, we're busy piloting this with income protection claims at the moment, and the results are promising.

00:16:02: We're seeing quicker turnaround times, more consistency, just a better experience.

00:16:07: So EHR-powered automation is certainly helping people get the support they need right when they need it.

00:16:13: Yeah, that's encouraging to hear.

00:16:15: So what's one way you think AI could shake things up here?

00:16:19: Is there something that still feels a little bit futuristic, but would be an exciting opportunity?

00:16:25: Absolutely.

00:16:26: If we were thinking about something that still feels futuristic but genuinely exciting, I'd be putting predictive underwriting right at the top.

00:16:35: Just picture this using AI tools that can analyze thousands of patterns across data sets and come up or propose a risk category for that profile.

00:16:46: We're not there yet, but the potential is immense.

00:16:50: Just imagine underwriting processes.

00:16:52: being more personalized and dramatically faster, no more guesswork, just better data-driven decisions.

00:16:59: Now that's the type of innovation that can transform the experience for both insurers and customers.

00:17:04: Yeah, that's a great example of where the industry could be headed.

00:17:08: And of course, every big innovation starts with practical steps and early initiatives.

00:17:14: So, but looking back at your pilots, what are some lessons you've learned?

00:17:20: I must say, electronic health records work best when everyone trusts the process.

00:17:25: We learned that minimizing disruption is key.

00:17:28: You know, if it's cumbersome or confusing for GPs or customers, it just won't fly.

00:17:33: It's got to be seamless for doctors and reassuring for policyholders.

00:17:37: That means we need clear communication, simple consent flows, and really solid data governance from the start.

00:17:45: Where do you see the most promising opportunities globally?

00:17:50: That's a great question.

00:17:51: If we look around the globe, we're seeing some really exciting opportunities occurring using electronic health records in life insurance.

00:17:58: For example, in developing markets, EHRs have the potential to skip over old school medical exams entirely and let people access their coverage much more easily.

00:18:10: In places like South Africa, insurers are already integrating with health labs, getting that data to help make decisions that are not just faster, but also fairer.

00:18:20: And what about other markets?

00:18:22: In the US, we're seeing more structured.

00:18:24: EHRs are starting to unlock real time underwriting.

00:18:27: This makes it possible to get an application completed in minutes as opposed to weeks.

00:18:32: Absolutely outstanding outcome.

00:18:35: So whether it's leapfrogging traditional hurdles or opening the door to new digital experiences, EHRs are making insurance just smarter and more inclusive everywhere.

00:18:44: And to our final question, Fast forward five years, what does a seamless EHR powered insurance experience look like?

00:18:55: Okay, well, picture this.

00:18:57: You log in, you give your consent with just a click and get a decision on your insurance in minutes, or you submit your claim form and it sends a request for relevant EHR data to be released from your GP with a decision shortly after that.

00:19:13: A totally personalized experience.

00:19:15: That's the kind of seamless EHR-powered insurance journey we're heading toward.

00:19:20: Yeah, thank you so much for sharing that Monique.

00:19:22: Sounds like a wonderful thing to look forward to.

00:19:25: Thank you.

00:19:26: So today we talked about the role of EHRs in our industry and why they're much more than just digital files.

00:19:33: We heard why EHRs are crucial for making insurance processes more accurate and how they're already transforming underwriting and claims.

00:19:43: Thank you for listening to RePlay by Hannover Re and we hope you found this conversation helpful.

00:19:48: Don't forget to subscribe for more episodes, leave us a review and stay connected with Hannover Re on LinkedIn.

00:19:54: Until next time!

00:20:06: The thoughts, ideas, documents and other content discussed or shared in this podcast are not intended to constitute any professional advice.

00:20:12: Hannover Re and the participants are not liable for any damages resulting from the usage of the content of this podcast.

00:20:18: For further information please see the show notes.